One Health – health policy in a post-COVID world

The COVID-19 pandemic and human-caused climate change, both bring to the fore the need for a politics and policies which look at the challenges we face as a whole, as an ‘ecology’. In other words: systems and relationships between issues become paramount.

Ecologism shies away from industrialism or the indiscriminate and careless use of resources to supposedly ‘create wealth’, the state capitalism of the old left and the laissez-faire and damaging individualism of the right, or indeed, the neither here nor there extreme centre.

Health policy is one area in which it may be easier to picture the relationship between climate change, our natural and urban environment, and our quality of life. In the past few decades, health professionals have become increasingly aware of the impact of our society on natural environmental process that threaten to upend the human ecosystem. In order to address this worrying concern, there has been a growing drive to frame the concept of health as a function not only of ‘healthy bodies’ but also as conditional on the health of the ecosystems which all of us as humans find ourselves in. The need for such framing has only increased in urgency over time, especially in recent years with the onset of climate change and growing awareness on the plethora of environmental problems facing the world today.

The ‘One Health’ approach to health policy has as its goal the achievement of optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment. ‘One Health’ recognises that we cannot divorce the natural world from the man-made world. Should the natural world not function properly, we can expect negative impacts on the human ecosystem. This includes various impacts and challenges in the areas, for example of food safety, the ethics (or lack of ethics, rather) of industrial farming, controlling zoonosis (that is, diseases which cross over from animals to humans), the decline of natural ecosystems that can lead to cascade events that spiral out of control, and antibiotic resistance.

The health of people is closely connected to the health of animals and our shared environment. Efforts that solely seek to address one aspect often fail. For example, given the current context, striving to ensure the protection of forest habitat would probably be a more effective means of preventing new pandemics (through reduction of zoonotic transmission risk) than merely waiting for pandemics to happen and provide vaccines.

Similarly, ensuring a healthy, active lifestyle and a nutritious diet for societies worldwide, through better food, access to safe air and water and urban green areas would be of greater benefit than merely providing medication to address non-communicable diseases.

Taken together and in a multisectoral transdisciplinary manner, a ‘One Health’ common approach adopted by policymakers, health professionals, scientists, engineers, architects and other professions could improve health and wellbeing for society at large, while mitigating significant health risks that emerge from poor environmental health. Through a collaborative spirit and good communication, various personnel from different areas of expertise could do much to address issues at the human-animal-environment interface which our society so sorely lacks.

A question which begs an answer is how can a ‘One Health’ approach to health policy be applied to Malta? ‘One Health’ is a ‘before treatment’ policy, it seeks to reduce health problems in the first place, rather than trying to cure the health problems caused by humans themselves. Malta would greatly benefit from the adoption of a ‘One Health’ approach, especially in the urban environment. Most urban spaces today are congested with traffic, crowded with little open space access (which when present is often in the form of a concrete patch) and poor building design.

Food security in Malta is increasingly precarious, with an overdependence on imported food. Maltese farming communities are often an afterthought, secondary to infrastructure projects that are, more often than not, increasingly obsolete and contrary to a greener, more sustainable future.

There is also a very apparent lack of transdisciplinary collaboration in Malta between ministries and professionals with various areas of expertise. In this respect, adopting a ‘One Health ‘approach would greatly benefit the Maltese public, the ecosystem in Malta at large and the wellbeing and quality of life of us all.

Even when it comes to the more traditional health policy, it is simply unacceptable that when a crisis strikes, we suddenly realise that medical and protective equipment, medical tests and medicines are either not manufactured at all, or not in sufficient amounts within the European Union.

Malta should insist on the establishing of an EU-based public research laboratory facilities and manufacturing capacity to ensure that essential medicines, medical equipment and testing are constantly accessible. Commercialisation of scientific knowledge should not hinder public health, ever. Cooperation should prevail over competition. Medical research should be based on universally accessible open science. This includes accessibility of scientific knowledge to public entities. A One Health approach to health, together with EU-wide rules which ensure the accessibility of science and research, made possible by the infrastructure, including the education system, paid for by the public, is the way forward.

Ralph Cassar
ADPD Secretary General
Published in The Maltatoday – Thursday 25 March 2021